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Authorization for pay with credit card
I authorize AIU High School to charge the following amount to my debit/credit card.
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* Indicates required question
Cardholder Name:
*
Your answer
Billing Address:
*
Your answer
Phone Number:
*
Your answer
Credit Card Type:
*
Visa
Mastercard
American Express
Diners Club Card
Other
Credit Card Number
*
Your answer
Expiration Date
*
Your answer
CVV:
*
Your answer
Amount to charge:
*
Your answer
Would you like to leave this card for automatic payments?
*
Yes
No
If yes, when would you like to get charged?
Your answer
Student ID / Email address
*
Your answer
Copyright © 2025 Andragogy International Universe, Inc.
Rev: Jan 2025
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